Purpose: To report a complex cervicothoracic vascular-osseous phenotype detected on CTA and define its surgical and radiological relevance. Methods: Neck CTA of a 76-year-old woman was reviewed on multiplanar reconstructions for aortic arch branching, supraaortic courses, vertebral artery segments, collateral channels, cervical ribs, styloid processes, and pharyngeal carotid relationships. Results: CTA showed a common origin of the brachiocephalic trunk and left common carotid artery (colloquially termed bovine aortic arch), bilateral rudimentary cervical ribs, high-riding pretracheal brachiocephalic trunk, and marked supraaortic tortuosity. The brachiocephalic trunk reached C7 and divided low in the neck below the right thyroid lobe. The right common carotid artery formed a proximal loop, and the right vertebral artery arose posteriorly from the right subclavian artery, passed anterior to the right cervical rib, and entered the C6 transverse foramen. On the left, the common carotid artery formed a 2.12-cm posterolateral arch loop. The left vertebral ostium, V1 segment, and proximal V2 segment were absent. A tortuous left deep cervical artery arose from the left subclavian artery, passed anterior to the left cervical rib, and reconstituted the distal V2 segment at the C3–C4 disc level; the distal artery continued as a PICA-type vertebral artery. Additional findings were a medial loop of the right external carotid artery, a 1.56-cm retropharyngeal/retrotonsillar loop of the right internal carotid artery, bilateral elongated styloid processes, and bilateral poor sternoclavicular joint articulations with the left brachiocephalic vein partly coursing in the resulting interclavicular space. Conclusion: The case illustrates interacting cervicothoracic variants that may affect anterior neck surgery, thyroid and pharyngeal procedures, tracheostomy, supraclavicular exposure, endovascular access, and CTA interpretation.

Background/Objectives: The trigeminal (CN V) and facial (CN VII) nerves are conventionally taught as separate pathways, yet extensive peripheral anastomoses form sensorimotor plexuses throughout the face. These communications provide the anatomical substrate for proprioception in facial muscles that paradoxically lack muscle spindles and Golgi tendon organs. This review aims to synthesise the anatomical, histological, and clinical evidence on these interconnections and to evaluate their implications across surgery, radiology, neurology, and dentistry. Methods: PubMed/MEDLINE, Scopus, and Google Scholar were searched for cadaveric dissection studies, Sihler whole-mount staining investigations, immunohistochemical analyses, quantitative axonal mapping studies, and clinical case series addressing trigeminal–facial communications and their diagnostic significance. Results: Twenty peripheral anastomoses were systematically identified and mapped, with prevalence ranging from reported-constant in multiple cadaveric series (auriculotemporal–facial trunk; mental–marginal mandibular) to variable (29–86%, depending on trigeminal division and method; V2 by cadaveric dissection, V1 by Sihler staining). Immunohistochemical evidence supports sensorimotor fibre interchange, and recent axonal mapping has revealed that the extracranial facial nerve is a mixed nerve containing motor, sympathetic, and afferent components. Clinically, these anastomoses are implicated in spontaneous facial recovery, trigeminal motor branch transfers, perineural tumour spread, local anaesthesia effects, synkinesis, and Ramsay Hunt syndrome. Conclusions: Available anatomical and histological evidence is consistent with the view that the trigeminal and facial nerves form a functionally integrated unit, though the functional significance of specific communications remains method-dependent. Recognition of these communications is relevant for surgeons, radiologists, neurologists, and dental practitioners managing facial conditions.

This review aims to provide an applied surgical–anatomical synthesis of the buccal fat pad, harmonise the commonly used extension nomenclatures, and summarise the principal neurovascular structures at risk, major clinical applications, and representative pathologies relevant to current surgical practice. A narrative, anatomy-oriented review was conducted using cadaveric, imaging-based (CT/MRI), and surgical literature. The evidence was organised thematically around extension anatomy, fascial boundary planes, neurovascular relationships, and procedure-related surgical risk. Two main extension frameworks, the 4-extension and 6-extension models, were identified, and their correlation improves anatomical orientation and comparability across studies. Key structures at risk include the parotid (Stensen’s) duct, buccal branches of the facial nerve, and the buccal and transverse facial vessels, all of which show variable relationships to the buccal fat pad. Safer surgery depends on accurate plane selection, limited dissection, and gentle mobilisation rather than forceful traction to reduce haemorrhagic and neural complications. The review also outlines clinically relevant pathology, including traumatic herniation or pseudoherniation and tumour or tumour-like lesions involving the buccal fat pad. An integrated applied-anatomical framework of the buccal fat pad, combining extension mapping with neurovascular risk awareness, may improve operative planning and support safer, more predictable aesthetic and reconstructive procedures.